Weight loss surgery refers to various surgical procedures, which are performed to control obesity by modifying the gastrointestinal tract and reducing its absorption of nutrients. This surgery is often termed as bariatric surgery. Prevalence of overweight and obesity has reached pandemic proportions and is contributing to premature morbidity and mortality because of increasing nourishment and a decrease in physical exercise.Surgery for weight loss has shown to be very effective for morbidly Obese patients.
|  | Weight loss surgery is generally advised only to those who are unable to loose excess weight either through diet and exercise programs and are Obese with related conditions such as hypertension,Diabetes mellitus and obstructive sleep apnea. It is possible that an individual can maintain a healthy body weight through this surgery.These procedures maybe carried out medically and safely but yet it is essential to understand the operative risks, mortality, side effects and after care before making such a decision.
| | Different surgical procedures
Surgical procedures for weight loss can be malabsorptive, restrictive or a combination of both these procedures.
Malabsorptive procedure: The procedure induces decreased absorption of nutrients by shortening the functional length of the small intestine, so that the body absorbs fewer calories. This procedure creates an abnormal situation for digestion and absorption of nutrients from food. Biliopancreatic diversion, duodenal switch, etc. are some procedures adopted for malabsorption. | 
| | Restrictive procedure: The procedure aims at reducing the size of the stomach by surgery and limits the food intake with reduced feeling of hunger.Vertical banded gastroplasty is done in which the stomach is stapled to forcibly create a smaller pouch and hence also known as stomach stapling. A silicone band called a lap band also creates the same effect.This method does not interfere with the normal digestion of food.
|  | | The reduced stomach capacity, along with behavioral changes, can resultin consistently lower caloricin take and consistent weight loss.Restrictive procedures are simpler to perform and are accompanied by less procedural complications than malabsorptive procedures. | | Combination operation: The procedure takes advantage of both restriction and malabsorption. In the gastric bypass surgery, a stapled stomach is created and connected to the small intestine. The upper part of the small intestine is reattached in a Y-shaped configuration. Hence the stomach volume is reduced and restricting food intake. In this case the stomach is disconnected from the duodenum and instead connected to the small intestine.
Most of these procedures can now be performed through Laparoscopy rather than an invasive surgery. Here less post-operative pain, reduced risk of wound infection,a shorter hospital stay, faster recovery and a more rapid improvement in quality of life maybe experienced. | | Success of surgery
The success of bariatric surgery is dependent upon long-term lifestyle changes in diet and exercise. The adaptation a patient makes to the new way of eating becomes very important. Clinical studies show that, following weight loss surgery, most patients lose weight rapidly and continue to do so until 18–24 months after the procedure. This largely depends on several factors such as patient’s age, weight before surgery, overall condition of patient's health, surgical procedure, ability to exercise, commitment to maintaining dietary guidelines, other follow-up care,motivation of patient and cooperation of their family, friends and associates. |  | | Adverse effects
As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures. Possible risks are bleeding, dehiscence, leaks from staple line breakdown, infections, complications due to Anesthesia and medications to name a few. Complications after surgery are frequently noticed in people over 40 years. A few of the difficulties faced while making adjustments after surgery are bloatedness, diarrhea after eating and Incisional hernia.
Important considerations- These weight loss procedures are not cosmetic surgerieshence an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure should be understood.
- Bariatric surgery should not be considered until all other options have been evaluated with the long-term side effects, such as possible need for re-operation, gall Bladder disease and malabsorption.
- Malabsorption leads to impairment of single or multiple nutrients thus leading to malnutrition and anemia. So, vitamin and mineral supplements above and beyond that of the normal person will be required.
- Several physical and social adjustments have to be made after surgery. The stomach pouch is reduced to about the size of a small egg and hence eating too much or too fast may cause either vomiting or an intense pain under the breastbone.
- These procedures also demand routine follow up of the patients particularly on their nutritional status. Associated complications like gallstones might occur and to prevent this, gall Bladder maybe removed.
| Health benefits of surgery
Surgery not only decreases body weight but also improves morbid conditions like high blood pressure, high cholesterol, diabetes, asthma, respiratory insufficiency, gastro-esophageal reflux disease, degenerative disk and joint disease to name a few. These patients on an average lose 61%of excess body weight depending on the procedure performed. | 
| However, patients need to be selected carefully for surgical treatment of obesity and have to be monitored closely over the long-term for nutritional deficiencies and other complications.
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